HL Deb 19 February 1975 vol 357 cc377-98

7.43 p.m.

Lord ABERDARE rose to ask Her Majesty's Government whether they accept the need within the National Health Service for a hospital where women patients can be sure of treatment by women doctors.

The noble Lord said: My Lords, the Rules of Order of this House result in some strange priorities in business, when we have to discuss the diseases of animals' in Northern Ireland before the diseases of human beings in England. This is, if, I may say so, a very important Question that I have on the Order Paper. I am sorry it has come on so late in the evening, because I know there are a number of Members of the House who are deeply interested and would have wished to be here if that had been possible. I am sure your Lordships will remember the original Question by the noble Lord, Lord Platt, which stirred up a great deal of interest in the House and which stimulated me to put down this Unstarred Question. The noble Lord, Lord Platt, is very sorry he cannot be here. My noble friend Lady Ruthven of Freeland had also wished to be here, and I am quite sure that the noble Baroness, Lady Summerskill, would have wished to be here if possible.

My Question relates to the whole principle of a hospital within the National Health Service serving the special needs of women, but I am principally concerned this evening with the Elizabeth Garrett Anderson Hospital in the Euston Road. I make no apology for returning to this subject because the hospital is devoted to a very special need, and I hope to persuade the noble Lord and the Secretary of State that it is of critical importance that its future be decided by the Secretary of State herself and not simply as a result of a decision by the Area Health Authority. The fact is that only 27 per cent. of the patients who attend this hospital come from the Camden-Islington area and it would be quite wrong to take into account only the Area Health Authority's point of view. It is the Secretary of State who is ultimately responsible for the National Health Service and this hospital serves a national, and not merely an area, need.

May I very briefly remind your Lordships of its history. Its founder was Elizabeth Garrett Anderson, a pioneer woman doctor, whose idea it was to provide surgical and medical treatment for women patients by women doctors. It was established on the present site in 1872, and was paid for entirely by voluntary subscription. It is worth remembering that it was an entirely voluntary hospital, especially when one considers what must now be the value of the site it occupies in the Euston Road. In 1948 it: lost its independence and became part of the National Health Service, and since then it has had the misfortune to have three different managements. First, there was the board of governors of the Royal Free Hospital; then it came under the North London Group Hospital Management Committee; and now it is part of the South Camden District of Camden and Islington Area Health Authority. I make no criticism of those managements, of course, but from the point of view of the staff who work there, it is rather upsetting to have to endure three different managements.

In particular, the reorganisation of the National Health Service has made things very difficult. Until recently the Elizabeth Garrett Anderson Hospital consisted of three separate buildings. There was the hospital itself, in the Euston Road; there was the Garrett Anderson maternity home; and there was Rosa Morrison House, a pre-convalescent unit. All three buildings, after the reorganisation of the National Health Service, were in different health districts. The main Elizabeth Garrett Anderson Hospital is in the South Camden district, the mater- nity home in the North Camden District, although it is managed from the South, and the Rosa Morrison House comes in Barnet.

I said "until recently" because some two years ago Rosa Morrison House was taken for urgent use by another hospital authority, thereby depriving the Elizabeth Garrett Anderson Hospital of some very valuable beds. As your Lordships will realise, pre-convalescent beds are most useful in freeing beds for acute patients in the main hospital. Yet I am informed that this valuable pre-convalescent unit now stands empty, except for one doctor and his family who live there. That does not seem to me a very good use of the facilities. Now, with the opening of the new Royal Free Hospital in North Camden, which has its own maternity services, the Garrett Anderson maternity home is threatened. It is not a particularly convenient building, but it provides maternity services for those who wish to be cared for in childbirth by women doctors. There are quite a few women—Muslim women, Orthodox Jewish women—who for religious reasons need that kind of care, and the Elizabeth Garrett Anderson Hospital without its own maternity beds is really inconceivable.

I should have thought that by far the better solution would be to move those beds from the Garrett Anderson maternity home into the main hospital. There is room for them where now there is an area with paediatric beds; and for a comparatively small expenditure these maternity beds could be integrated into the main hospital. The result would be an overall saving in running costs.

The hospital faces another difficulty in relation to its nursing staff. It used to form part of the nurse training school of the North London Group. Now the General Nursing Council has withdrawn recognition on two grounds: first, that the hospital does not provide experience not available elsewhere; and, secondly, the physical conditions of the hospital. However, these have been improved since the General Nursing Council reported, and with more finance could be improved still further.

The position now is that there is a new nurse training school at the new Royal Free Hospital, and a nurse train- ing scheme in full flood—I think an experimental one—at the University College Hospital. In these circumstances, it is obvious that a small hospital cannot compete, and in June is to lose all its student nurses. No wonder that those who have devoted their lives to this hospital feel desperate. A small and excellent hospital, providing a unique service to women, is being slowly throttled out of existence. Buildings now over a hundred years old, but still solid, are being allowed to deteriorate; staff are being replaced by locums instead of permanent members; insecurity is leading to resignations and, incidentally, is affecting morale.

My Question asks whether the Government "accept the need within the National Health Service for a hospital where women patients can be sure of treatment by women doctors". It therefore covers also the South London Hospital which provides a similar service for women, although, so far as I know, at the moment it is not under a threat of closure. But it is the answer to this general question on which the future of the Elizabeth Garrett Anderson Hospital depends.

It does not serve a district need nor an area need. As I have already said, only 27 per cent. of its patients come from the Camden-Islington area; 98 per cent. of them come from the South-East of England as a whole. When I visited the hospital recently, there was a lady from the Sudan who had specially come over with her husband to go to that hospital. It is no good putting the problem to the Area Health Authority; it is a national problem to which the Secretary of State must give an answer. I hope that, as a woman, she will see the need to retain this hospital.

Why should we destroy a small, specialised, highly successful hospital for the sake of size and uniformity? Certainly none of the patients who have been there would wish this to happen. Support has been coming in from all over the country, and, when I last heard, there were already over 10,000 signatures. I ask the Government to recognise that the original initiative of Elizabeth Garrett Anderson has demonstrated by its very success that a need exists for such a hospital as this. I ask them to agree that it is a national need which demands national support; and this should be made available to the district from national funds.

I have one suggestion to make: if the Government will consider making special funds available to keep the hospital going, I would suggest that in return the Elizabeth Garrett Anderson Hospital itself should be allowed to appeal for funds to support its work. I have no doubt that —in view of its place in women's affections, and the support that it enjoys from women's organisations all over the country —such an appeal could raise very large sums of money. I hope that this would therefore go to reduce the amount of money that the Government themselves might have to find to keep the hospital going.

Above all, I ask the Government for a quick decision. Those who work in the hospital will fight to the last to keep it open, but even they would prefer to know soon if the decision goes against them, rather than suffer a lingering death of slow attrition. But best of all let the hospital be given a new lease of life to continue to provide devoted service to women, and to further the ideals of Elizabeth Garrett Anderson.

7.55 p.m.


My Lords, I should like to say how much I am in agreement with the noble Lord, Lord Aberdure, in what he has said. He went over the original objects of the hospital, which I should like to repeat. It was originally built for women patients to be cared for by women doctors, for the training of nurses, and the training of women doctors. These objects still apply today. Not only do many British women go to it but, as the noble Lord said, and as the noble Baroness, Lady Summerskill, said a few weeks ago, there are many women of other faiths who go to this hospital, whether they be Muslims or of the Jewish faith, because they like seeing a lady doctor. I should add here that at one time I had a lady doctor, and I can firmly recommend them as being every bit as good as any man. I should like to ask Her Majesty's Government whether they realise that there have been over 10,000 signatures collected for retaining this hospital.

I should now like to go into some possible reasons for the closure, and make some suggestions as to why it need not be closed. One of the reasons that I was given was that there is no need for the Elizabeth Garrett Anderson Hospital to exist any more. One answer to that is that the hospital is as full as it ever was. Another point was that it does not fit in with the reorganisation, or fulfil the local district needs. The noble Lord, Lord Aberdare, has already said that 98 per cent. of the patients come from the South of England, and therefore it is a very special hospital and it could be funded from special funds. Another reason given for closure is that the buildings are old and shabby. But so are the majority of other hospitals in this country! Is there any reason why it could not be upgraded? Even if it was eventually rebuilt—because the present site must be extremely valuable land—it could be resited. At least it should be preserved, even if not on the same site.

The noble Lord, Lord Platt, said on 21st January that the school of nursing has been discontinued, and the reason given was that it was too small and too limited. But alternative arrangements are already being made, as the noble Lord, Lord Aberdare, said, and even better arrangements could be made in the future. Perhaps Her Majesty's Government could tell me why they feel that the nurses do not have wide enough experience and learning at Elizabeth Garrett Anderson.

However, most important, in my humble opinion, is that the work and the traditions of service, and of individual attention to women patients, are maintained. The Elizabeth Garrett Anderson must not be closed for the sake of the stroke of a pen, or of red tape, bureaucracy, whatever you call it. I am sure that most Members of your Lordships' Chamber would agree. There is still, and there always will be, a need for a hospital for women, nursed by women, and attended by women doctors.

7.59 p.m.


My Lords, I am grateful to my noble friend Lord Aberdare for introducing this debate. The problem of whether or not there is a need for a hospital staffed by women doctors for women patients is clearly bound up with the future of the Elizabeth Garrett Anderson Hospital, about which questions were asked in your Lordships' House on 21st January.

Over the years, it has been my privilege, as a doctor, to have looked after certain members of the Anderson family, and I know how proud they have all been of their pioneering medical ancestor, our first woman doctor— Elizabeth Garrett Anderson—who founded in Seymour Place, in 1866, a dispensary for poor women and children. In 1872 she built The New Hospital for Women in Marylebone Road, which was paid for by womens' organisations and members of the Anderson family. This hospital was developed for two main reasons: To have some of the first women doctors on its staff in many specialities (by no means only gynaecology and obstetrics) at a time when they had the greatest difficulty in being appointed to other hospitals; and as a place where women patients could be treated only by women. In 1899 this hospital was rebuilt on its present site in Euston Road; and in 1917, when Elizabeth Garrett Anderson died, it was renamed after her.

Some of my patients have been treated in this hospital, and I know how useful it has proved and how well it has fulfilled its two main functions. It is almost unique because, because so far as I know, there is only one other hospital in England run by women for women—the South London Hospital for Women and Children, which docs take young gentlemen up to the age of 10. In the Elizabeth Garrett Anderson Hospital not only the doctors are women but also the nurses, medical students and student nurses, and, also, very nearly all the rest of the staff. Just before the war there was a male stoker, but he was kept underground! Since then, over a period of years, they have had one male consultant anaesthetist and two registrar anaesthetists, one male consultant radiologist, and several male porters.

In our gardens, my Lords, I am sure that many of us must have found that it is usually a mistake to cut down, without very careful thought, indeed, a tree which has been growing for more than 100 years, unless it is certainly dying, is in the wrong place, doing harm to or taking water or nourishment away from other plants, and until something really better has been found to replace it. This famous hospital which we are discussing this evening is more than 100 years old. It has been somewhat starved of funds lately, and it is not altogether healthy. It has had one branch lopped off already (its pre-convalescent home in Barnet); it is losing another this spring when its student nurses are being removed; and a further branch (its maternity home in Hampstead) is now in imminent danger of being closed. Its main trunk, however, still flourishes, albeit under somewhat difficult conditions.

I have spoken to senior members of its staff and to the Medical Officer of the Camden and Islington Area Health Authority. There are, without doubt, a great many things wrong with this hospital, and it is generally agreed that the present overall situation is untenable. Among the disadvantages is the fact that it is on rather a noisy site on Euston Road —a site which was chosen deliberately near to several railway termini for the convenience of patients coming from the Northern Home Counties and the Midlands. Its fabric is outworn; one of its two lifts needs to be replaced. Paying for this hospital is difficult because it has a wide catchment area: only about one quarter of its patients come from Camden and Islington; about four-fifths are from London postal districts, and 98 per cent. are from South-East England, mostly from North of the Thames; 2 per cent. come from further afield, and are, perhaps, of Moslem faith from overseas. For religious or cultural reasons, they do not wish to be looked after by men.

It has 107 beds for a great variety of medical services. With its maternity home, it has 19 consultants, five locum consultants and just over 20 junior medical staff. All its consultants work part-time in the National Health Service —in general medicine (including diabetes), general surgery (including breast diseases and urology), gynaecology (30 beds), with family planning and fertility clinics, dermatology, rheumatology, neurology, psychiatry and physical medicine; in addition, anaesthetists and pathologists are required. Its obstetric service—with accompanying pediatric cots—and antenatal and postnatal care—some of the most important parts of a hospital for women—was moved 27 years ago to Hampstead where its maternity home has 32 beds; but this is likely to be closed shortly for various reasons, one of which is that there is an excess of maternity beds around there. The consultants hope that these maternity beds will be returned to the main Elizabeth Garrett Anderson Hospital where, by right, they should be; but the Area Health Authority, I believe, would like to see them absorbed by the new Royal Free Hospital. Within the main hospital there are four private beds, usually filled with patients from overseas or from the National Health Service, and two National Health Service amenity beds which are often occupied by retired nurses or doctors.

Just over 100 female beds is not considered enough to give student nurses a comprehensive training, even though some of these students have been seconded to other hospitals, with men patients, as they were to the Seamen's Hospital at Greenwich before they went to hospitals in the North London Group. The recent reorganisation of the National Health Service has taken the nurses' training school of this group into another district. For these and other reasons, the General Nursing Council, as you have already heard, is shortly to withdraw its approval for the training of student nurses at the Elizabeth Garrett Anderson Hospital, although it is fully recognised how excellent has been the nurses' training which has taken place there. When student nurses are withdrawn, they will have to be replaced by fully-trained, perhaps agency, nurses who will be more expensive.

On the other hand, my Lords, this hospital has many advantages. With its fine pioneering traditions, and the splendid work which has been done in it for more than 100 years, the consultants and sisters are proud and happy to work there, and the great majority of the patients are contented, too. The nursing care is, without doubt, splendid; and the gynaecological teaching of women students from the Royal Free Hospital has been excellent. Another advantage is that this hospital has enabled young married women doctors to work there part-time, on a sessional basis, allowing them to keep in touch with their profession and promote their continuing medical education, between having babies or while looking after their families. Later, when their children have grown up they can then return efficiently to full-time specialist posts or go into general practice.

There is no doubt whatever, my Lords, that some women patients, especially those who are shy or adolescent, like to be cared for by women doctors and not only for gynaecological and obstetric conditions; just as most men prefer to be looked after by male doctors and not only for particularly masculine complaints. Some people might be tempted to ask how women in other parts of the country get on, and are the two women-for-women hospitals in London really necessary? My answer to that would be that if there were more of such hospitals in other parts of England they would almost certainly be used and it is likely that many women patients would be happier. There is something attractive to many patients, to their doctors and to staff about smaller hospitals which tend to be more friendly and personal than the very large ones and which are often preferred for the care of common or simple complaints, for which expensive equipment or services are not required.

The problems we had a few years ago with small general-practitioner or cottage hospitals were, I know, quite different from those which we are now discussing; but in some ways they were comparable. For administrative convenience, and for economy, an effort was made, and much pressure was brought to bear, to close many of these smaller hospitals which doctors, their patients, and their patients' relatives: and friends had found so very useful and convenient over the years. After much discussion and heart-burning, common sense prevailed; and many of these small hospitals have now been preserved and are still doing splendid work, having been brought up-to-date and made more efficient, perhaps with modifications and adaptation to wider uses, with more staff than before, and even under a new name —"community hospitals ". In considering the problems of the Elizabeth Garrett Anderson Hospital, we all realise that the opening of the new Royal Free Hospital in the same area merits a most careful reassessment of local funds, administrative arrangements and of medical staff and nursing resources. Administration and finance are fundamental; but other things are important, too—personal, humanitarian, emotional, and to some extent traditional factors play a major role which must be taken into account, and cannot be ignored.

What of the future of the Elizabeth Garrett Anderson Hospital? Is it viable? Should it be wound down or closed quickly? If not, how best can it survive and even grow? Its future may well be much brighter than many people expect. There is no serious vendetta between the Area Health Authority for Camden/ Islington and the senior staff of the hospital. They both want to find the best possible solution of this difficult problem. Friendly discussions are already taking place between them, and with the local community health council. I have heard today that a letter has been received which suggests that the Department of Health and Social Security is taking a special interest also. More than 10,000 signatures have been obtained, mostly from women, supporting a petition in favour of keeping this hospital open; and nearly all the general practitioners who send patients to it want it to continue, too. As it is not altogether a local hospital, methods of paying for it will have to be worked out between the Department of Health and Social Security and the area and district health authorities. There is an urgent need now for a lead to be given by the Department of Health and Social Security and by the Secretary of State for Social Services who is ultimately responsible for the future of this hospital and its maternity home, and for the financing of both.

Is it to be refurbished on its present, valuable site, at considerable expense, being loosely linked to a larger hospital in the same district, such as University College Hospital, which will allow it to use certain expensive diagnostic and treatment equipment, and medical or nursing training facilities? Is it to be rebuilt on another site, which will be more expensive still? Is it to be integrated or incorporated into a larger hospital not far away, its staff being given a few wards or a wing allocated to the treatment of women by women, with a plaque commemorating Elizabeth Garrett Anderson on its walls? We must remember that some large hospitals are still uncertain of their own futures; and not all accept the principle of women being treated only by women even in a few of their wards. There is an enormous difference in status and prestige between working in one's own hospital bearing a famous name, with a great and proud tradition behind it, and being relegated to just a few wards of a much larger hospital which has been kind enough to accommodate a poorer and older neighbour. It has been said that integration is what the cat offered the canary; and if you want the canary to sing it should be as an equal partner.

In conclusion, my Lords, I should like to repeat that the hospital founded by Elizabeth Garrett Anderson has been in use now for more than a century. It has been giving extremely valuable and particular services to many women consultants and innumerable women patients, and it would be more than ironical to abolish it during the current International Women's Year! Even if it is not pulled down, many doctors and patients will be most upset if it were to lose its identity and character. A recent report from the South Camden Community Health Centre said that suggestions had been made for adapting the building as a psychiatric day-centre or a centre for inadequate mothers. I, as a practising doctor, would like to add my name to those who are making a plea for the preservation, if this is reasonably possible, of its present building, its name, its work and of everything else for which it stands, while fitting it efficiently into the framework of our National Health Service as this is organised at present in North London. If it cannot be preserved, one hopes that a suitable alternative will be found, nearby, before the old hospital is closed down.

There is need, now, for a wide assessment throughout the country of how many women really do prefer to be looked after by women doctors. If this number is found to be significant, I should like to make another plea for wards, clinics or departments named after distinguished women doctors, local or otherwise, to be developed in or near district general hospitals in other parts of Britain in which women can be cared for by women. This would widen the field of work of many women consultants some of whom still meet a certain degree of prejudice against them when they apply for hospital appointments; it would make many women patients throughout the country happy; and it would be in keeping with the wonderfully courageous, pioneering spirit of Elizabeth Garrett Anderson herself and of those who worked with her 100 years ago.

8.18 p.m.


My Lords, I apologise for entering this debate not having put my name down, but at this late hour I shall trespass on the time of your Lordships for only about four minutes. But I think that from this side of the House there should be some "say so "about this fundamental problem. I have listened with great interest to the cogent and constructive statement made by the noble Lord, Lord Hunt of Fawley, who is a distinguished member of the medical profession, who speaks with authority and who has made a constructive case. I have listened to all the speakers except for one moment when I had to leave the Chamber, but I would enter a caveat. I think that the medical profession should tread softly when it is talking about a private medical service. The majesty of the National Health system, whatever criticisms it may have had, is unmatched anywhere else in the world. If we were to follow an arid agreement that we would sweep back into the old private system of medicine that I knew as a child in South Wales, all those ideas would go to the wall.

Nevertheless, I feel that I must support the plea. I hope that we will get an answer to the main question, because the noble Lord, Lord Aberdare, to whom I also listened with interest (I always do, because he takes such care to put his point of view without acerbity and constructively) is to ask Her Majesty's Government whether they accept the need within the National Health Service—this is the 64,000 dollar question—for a hospital where women patients can be sure of treatment by women doctors. It may seem strange towards the end of the permissive 20th century, when there is probably more permissiveness than in the days of the 18th century and even than in the 13th century, to find this plea. Nevertheless, those of us like the noble Lord, Lord Aberdare—who himself comes from Wales—know that in the remoter parts of these islands there are still women who want to be tended in this way. While I would not encourage blind prejudice when there may be first-class medical attention from a male doctor who is present, such as sometimes occurs with Jehovah's Witnesses who allow themselves to die refusing medical attention, there should be within our Health Service something which could meet the demands of women who want women doctors.

There was no specific mention of the hospital in the Unstarred Question, but I should like to add to the plea that, in International Women's Year, we should not see the demise of this wonderful system of hospitalisation. Furthermore, when the Opposition have had the courage: to pick a woman as the Leader of a great and historic British political Party, it would be sad if we had no agreement in the National Health Service that women patients could be attended by women doctors. I should like to press my own Front Bench, even if they cannot give a constructive answer tonight to what the noble Lords, Lord Aberdare and Lord Hunt of Fawley, and the noble Earl, Lord Kimberley, have said, to say that some formula can be found by which, under the National Health system—once we have overcome the bitterness that recently seems to have crept in over consultants and so on—the people of Britain will be prepared to bear the burden of this demand on the part of some women.


My Lords, I hope the noble Lord realises that the hospital in question is now part of the National Health Service. It is not a private hospital. It is providing these facilities now and all we want is that the National Health Service should continue to support it.


My Lords, it would not be able to keep going if it did not. It is not mentioned here— that is the point. I absolutely agree that I should like us to find a formula by which the hospital could be kept alive and I was particularly interested in the point made by the noble Lord, Lord Hunt of Fawley, about Muslim, Jewish and other women who have religious views. I must not use the word "prejudice". We have to be careful when we apply that word to another person's belief in his or her God. From the therapeutic point of view and for the cure of the illness, the person in question may believe what he or she wants to believe and, if it is a woman and she wants a woman doctor to attend her, I believe that her chances of being cured—though I could not argue this point with the medical profession—would be slightly improved by having the satisfaction of receiving the kind of medical attention for which she has asked. My Lords, having said that—and I have taken five minutes instead of four—I appeal to my colleagues on the Front Bench to tell us whether there is some formula by means of which this hospital can be kept going, and kept going worthily in this international Women's Year.

8.22 p.m.


My Lords, I do not want to delay the Answer which is to be given by the noble Lord, Lord Wells-Pestell, for more than a moment but, as the only woman in your Lordships' House tonight—I beg the noble Baroness's pardon; I see that the Chief Whip has come in—I should like to say that I know that the noble Baroness, Lady Summerskill and Lady Phillips, share the same view as has been so excellently put forward by my noble friend Lord Aberdare, and so convincingly expressed by the noble Lord, Lord Hunt of Fawley. I should also like to add the voice of a woman to the plea that has been made to the noble Lord, Lord Wells-Pestell. to consider this problem carefully and to approach it very sympathetically indeed.

Though I do not know the hospital in question, I have followed the correspondence in The Times and various other newspapers, and the strong pleas that are being made that the hospital should continue in the traditions in which it has been built up. Though they are perhaps not unique, they fill a gap and a need in the Health Service and I am sure that the noble Lord will give us a very sympathetic hearing on this matter. I should like to support by noble friend Lord Aberdare and the noble Lord, Lord Davies of Leek, in their appeal.

8.24 p.m.


My Lords, I, too, refrained from putting my name down on the list of speakers. I did so for the reason that the more deeply I delved into the evidence for the continuation of this admirable hospital and the more I was able to consider that evidence, the more reluctant I became to speak too dogmatically on one side. However, I hope that my noble friend Lord Wells-Pestell, when he comes to reply, will be able to make out a really strong case for justification of three important points which have been heard. First, there is the justification for having a women's hospital staffed solely by women. We have been told that only two remain, both in London. The noble Lord, Lord Hunt of Fawley, made a very strong case for building new hospitals exclusively for woman patients. That is, I imagine, a policy which any Government would be bound to defer. But what is the justification for maintaining a small hospital in these days? When I was faced, as a medical student, with the choice between receiving training in a small or a large hospital, I opted without the slightest tinge of regret for a small hospital. My only regret subsequently has been that that small hospital—the Westminster Hospital—was later converted from a small establishment with 250 beds, on a magnificent site in Broad Sanctuary, between Westminster Abbey and the Methodist Central Hall, to another site in Horseferry Road and transformed into a large hospital with between 500 and 600 beds. At once it lost its intimate, personal family character, which to me is a source of great regret. The same thing has happened to Charing Cross Hospital, which was also located on a magnificent site right in the centre of London and is now a large hospital somewhere down the Fulham Road. One can only look back on these events with enormous regret.

The other point is how far there is justification on religious grounds for maintaining a hospital. We have heard of the sensitivity of members of different faiths. I should like to feel that in any hospital those deep religious feelings would always be taken into account. Whether that presents a case for a special hospital staffed exclusively by women to meet those sensitivities is another matter altogether. However, I think that we all realise that the Elizabeth Garrett Anderson Hospital is a hospital of quite outstanding traditions which has been working for a number of years under appalling difficulties. First, it suffered a crippling blow with the withdrawal of its facilities as a hospital for the training of nurses. I should like to know how far that privilege could be restored to the hospital. I should also like to know, as the hospital has pleaded on so many occasions for improvement of the physical conditions under which the staff have to work, what can be done about this?

I can see no mention in the reports of how far the hospital has been able to go to meet these crippling physical handicaps. So far from agreeing with the noble Lord, Lord Aberdare, that a decision must be reached quickly to put the hospital out of its suspense—and, as we know, that suspense has been continuing for many years—I should like to ask my noble friend Lord Wells-Pestell, whether a thorough inquiry has been made into the improvements which the hospital has already effected in its physical conditions? We know that it is a hospital which is well over 100 years old, but that does not necessarily debar it from being modernised and extended, even on its existing site. Let us remember that originally the hospital came in under the National Health Service. It is a tribute to the hospital that it willingly undertook to serve under certain restrictions and difficulties. I imagine that the difficulties were mainly of a financial nature.

But let us remember that there is one hospital in London today that is still standing outside the National Health Service. This hospital was originally founded for the benefit of trade union patients. It has been able to survive only because of the support it has received from the trade unions. I refer to the Manor House Hospital. Here we have an instance where, for some reason or another, conditions of joining the National Health Service do not apply. Whatever the justification may be on the part of this hospital for staying out of the National Health Service, I believe the only answer is that it is able to maintain itself financially through the contributions of the trade unions and does not fall into the National Health Service scheme which, after all, was initiated by a Labour Government.

These are all factors which must be taken into account. No more sympathetic and understanding Minister has been able to speak for the Department of Health and Social Security in my long recollection than the present spokesman on our Government Front Bench. We know how deeply he feels on these matters; we know the extent of his sympathy and— as has been mentioned already this evening—we know of the extraordinary degree of physical tenacity with which he has placed himself repeatedly at the disposal of this House. I hope that when the time comes to make out the case for the closing of this great and historic institution, the Government will be able to make out a really strong and convincing case to justify their action.

8.32 p.m.


My Lords, this is indeed International Women's Year, because I gather that the mantle of my noble friend Lady Summerskill has fallen upon the shoulders of, shall I say, the noble Lord, Lord Aberdare. I think she would be very pleased with him were she here, and certainly she will be very pleased when she reads Hansard. My I noble friend Lord Davies of Leek has said he hopes that there will be an Answer to the Question on the Order Paper. There will be an Answer—but whether it is a satisfactory Answer remains to be seen. The noble Lord's Question has given rise not only to an interesting discussion but to a rather interesting situation. Nowhere in the Question are the Government asked to express an opinion about the Elizabeth Garrett Anderson Hospital, and I see it as my duty tonight to answer the Question rather than to permit the Question to be used as a vehicle for raising the matter of the Elizabeth Garrett Anderson Hospital. However, I would not treat the noble Lord in that way and I will make some references to that hospital. One must bear in mind, however, that it can be only a reference, because of the reasons I have given.

It is important to set the question of the treatment of women patients by women doctors in its context. I have said before and I will say it again, that I am very much impressed by the very balanced argument which the noble Lord, Lord Hunt of Fawley, has put tonight, and which he always puts, in which he helped the House, and certainly Ministers, by putting forward the pros and cons.

We have to bear in mind that under the National Health Service Reorganisation Act 1973, the Secretary of State for Social Services and the Secretary of State for Wales have a duty to provide, through-out England and Wales., hospital accommodation and such other services as are required for the diagnosis and treatment of illness, and here I quote the Act to such extent as she considers necessary to meet all reasonable requirements". The operative phrase there is, "reasonable requirements". I do not want to discuss at this stage whether or not the matter before your Lordships' House is reasonable. This is a matter that must be decided, and is in the process of being decided; but I will come to that in a moment or two. There is a very wide responsibility in relation to diagnosis and treatment, and also a very wide discretion as to how this responsibility should be carried out.

The key to the use of this discretion is however clear. Hospital facilities have to be organised to meet the needs of the community as a whole, having regard of course to available resources. The need for health facilities and indeed the demand for them varies from locality to locality depending on, for example, the age structure of the population and the patterns of morbidity and mortality. Moreover, ever since 1948 we have seen an increase in the complexity of medical care and an ever-increasing recognition of interdependence of the various branches of medicine in the treatment of the individual patient. Accordingly the pattern of hospitals which has been developing is the replacement of the smaller and single speciality hospitals by district general hospitals. This is what the 1973 Act was asked to do, and it is something which Parliament accepted.

These hospitals, whether in one new building or operating as an integrated organism from several new or existing buildings, provide facilities covering all major specialities including gynaecology, obstetrics, geriatrics, psychiatry and surgery. Additionally in the district there will be community hospitals for those patients in need of in-patient treatment of a less specialised nature than that generally provided at the district general hospital. In this way the most up to date and appropriate care of the patient and the most economical use of skilled man-power and technical facilities can be achieved. This is something we cannot afford to ignore. We have to provide on a general district basis not only appropriate care, but economical skill on manpower and technical facilities. What has never been possible is to guarantee that patients attending, or being admitted to, a hospital can designate the doctor who is to treat them; or, equally, can specify that they are to be treated by doctors, or other staff, of one particular category.

It has therefore never been possible to guarantee for the population as a whole that a patient can be seen by a doctor of one particular sex. I think the practical reasons for this must be fairly obvious. For instance, it would mean discriminating between the sexes in the appointment to hospital posts. Moreover, it would be impossible in hospitals generally to ensure that a doctor of one particular sex was always available during holidays, or at night to deal with emergencies. It would raise a whole series of problems. But this does not mean that the wishes of patients are to be ignored.

Within the general framework of the organisation of hospital services, efforts are made to meet the susceptibilities of individuals or groups in so far as this can be done in a way which does not unduly disrupt the services for the generality of patients. Thus at hospitals where there are women doctors in the relevant specially, we would hope that patients who, on conscientious or other serious grounds, want to see a woman doctor could be allowed to do so, provided that this could be done without disturbing the work or imposing too great a burden on the individual doctor. How far this sort of arrangement is practicable in individual hospitals is, of course, dependent on the local circumstances.

Furthermore, where there is evidence of demand, perhaps from religious or ethnic groups or from women generally, health authorities would no doubt be willing to consider notifying the groups who make representations of the names of hospitals in their districts which have women doctors, and notifying to general practitioners the names of hospitals having women consultants to whom women patients could be referred if they so wished. This, then, is the general position. I turn now to the particular topic of single-sex hospitals.

The noble Lord's Question refers to the need for a hospital within the National Health Service which would satisfy the wish of women patients to be seen by women doctors. I cannot imagine that the provision of one hospital, even one based in London, could be a satisfactory way of meeting the wishes of women in the country as a whole, who would prefer to be seen by women doctors. Nor would the Government consider that the establishment of one or more new single sex hospitals would be desirable. The practical problems of staffing and the difficulty of assessing the demand for this facility would mean a wasteful use of resources of all kinds.

Nevertheless we would not want to close any existing single-sex hospital if it was giving a useful service to the community, so long as it remained viable, and provided that its costs were not excessive in relation to the benefits provided. The latter point is important because if a health authority is required to keep open a hospital it does not need, then it is forced to spend its resources in an inefficient manner at the expense of leaving other health needs unmet.

I do not want to sit down before making some reference to the Elizabeth Garrett Anderson Hospital because obviously this was in the mind of the noble Lord, Lord Aberdare, and of others who spoke. But I am in a difficult position and I want to be frank about it. I am not in a position to add to what I told your Lordships as recently as the 21st January last—which is just over three weeks ago. The position has not moved all that fast. It cannot move very fast when negotiations are going on, not only with one group but with a number of groups within the medical profession.

Because the hospital was founded with certain special objects, no decision on its future can, as I said on 21st January, be taken without the consent of the Secretary of State. The discussions which have taken place up till recently were informal only. My right honourable friend the Secretary of State for Social Services has now authorised the Area Hospital Authority to proceed to formal consultation on the future of the hospital. This was a point raised by Lord Hunt of Fawley. The Community Health Council will, of course, be closely involved in any consideration given to the future of the hospital. Let us say at this stage that the Community Health Council is in existence to be concerned with, and to concern itself with, the needs of the people. This is perhaps one of the great features of the Community Health Council.


My Lords, the Community Health Council is interested only in its district and in its district needs and will no doubt look on the Elizabeth Garrett Anderson Hospital from the point of view of serving the district. What we have all been trying to say is that this hospital is serving a need that I expressed as a national need, or a need for the whole of South-East England. It is this aspect of the hospital which it is so important to emphasise.


My Lords, with respect, I think that the noble Lord would be on stronger ground to mention that something like 84 per cent. of the women attending this hospital come from the London postal district.


My Lords, some 98 per cent. come from the whole of the South-East of England.


Yes, my Lords, this is true. But there are these figures; and 84 per cent. of the people who attend come from the London postal districts while 98 per cent. come from the whole of the South-East of England. These figures are not incompatible.

The Area Health Authority has agreed that the necessary funds should be made available to overcome extra costs arising from the: need to recruit qualified nursing staff to replace student nurses as they are withdrawn until such time as a review of the hospital has been completed. I do not think that this is a matter which can be hurried. As the noble Lord, Lord Hunt of Fawley, will know, when a matter of this kind is being considered there have to be rather long and deep consultations at a number of hospitals. I can say that those consultations are taking place. I can say that the ultimate decision has to be made by the Secretary of State.

I think that the noble Lord, Lord Aberdare, has rendered a service in bringing this particular matter before your Lordships in the form of an Unstarred Question. Those noble Lords who have taken part in the debate in the main have some real knowledge of what is needed. I am certain that my right honourable friend the Secretary of State will read this debate with some considerable interest.